TITLE: SGS-Medical Billing Appeals Specialist (1329360)
TERMS: Possible Temp to Hire -Contract-July 01, 2024 - September 28-2024
LOCATION: REMOTE
HOURS: 8:30-5:30 Monday- Friday
Hourly Rate: $28.00
Job Summary
The Claims Specialist-Appeals assesses and facilitates ongoing support for Sedgwick Government Solutions (SGS) Claims Operations. Responsibilities include assessing and handling appeals; serves as the subject matter expert for claims appeals; and to serve as the liaison between claims operation and the client.
Job Description
Essential Functions
Duties and Responsibilities
- Gathers and reviews claim appeal documentation including, but not limited to, appeal request letters, and medical documentation.
- Reviews medical documentation and provides claim expertise on appealed claims.
- Prepares appropriate claim Form to client summarizing the appeal review determination.
- Adheres to the highest quality and ethical standards when reviewing appealed claims and making determinations.
- Ensures integrity of the claim appeal process and ensures compliance with the Client’s requirements.
- Monitors and tracks the number of appealed claims.
- May perform other duties, as needed, to meet the needs of the business.
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Job Specifications
Education
- High School Diploma or GED required
- Preferred bachelor’s degree in healthcare, medical bill review (claims) processing or a related field, education may be substituted with experience including four or more years of experience in medical bill review (claims) processing.
- Preferred Medical Billing and Coding Certification- CPC-Certified Professional Coder, CBCS- Certified Billing and Coding Specialist, CCS-Certified Coding Specialist, or CPC-Certified Professional Coder.
Experience
- 4 years of experience in medical billing or, processing
- Medical coding experience, is a plus
- General Medical record knowledge and requirements
- Familiarity with federal fee schedule, Medicare, Medicaid, Tricare, Veterans Administration or any federal fee schedule bill review experience is a plus
- Excellent oral and written communication skills
- Excellent presentation skills
- PC literate, including Microsoft Office products as well as MS Teams
- Strong organizational skills
- Excellent interpersonal and negotiation skills
- Travel as required
- Ability to work independently and in a team environment.
- Ability to work remotely.
Job Types: Full-time, Contract
Pay: Up to $28.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Application Question(s):
- Do you have either Medical Billing or Medical Processing experience?
Experience:
- Medical Billing or Processing: 4 years (Required)
Work Location: Remote